GESTIÓN DE LA ASISTENCIA SANITARIA EN BRASIL - Auditoría Coordinada (Resumen Ejecutivo)

Report ID: 364

Con una gran población, Brasil tiene como una de sus misiones más difíciles y complejas garantizar el acceso universal, equitativo y gratuito a los servicios de salud, un derecho consagrado en la propia Constitución Federal. En este sentido, la implementación de esa política pública se enfrenta a muchos desafíos, como en el caso de la descentralización de las acciones, las fuentes de financiación, los recursos humanos necesarios y la gestión de los recursos financieros disponibles.

La atención primaria de salud es el principal punto de entrada y el eje de comunicación de toda la red de atención de salud; y debe ser el contacto preferido de los usuarios del Sistema Único de Salud (SUS). En este nivel de atención se identifican las principales necesidades de la población, lo que influye en la planificación y gestión de los demás niveles.

La atención primaria de salud fue objeto de esta auditoría de gestión coordinada realizada por el Tribunal Federal de Cuentas (TCU) y por 29 Tribunales de Cuentas (TC), firmantes del Acuerdo de Cooperación Técnica suscrito el 25 de marzo de 2014. El objeto de esta fiscalización era evaluar, mediante una auditoría coordinada, los aspectos relacionados con la prestación de servicios, el acceso, la infraestructura y la capacidad de resolución de problemas de la atención primaria de salud a los ciudadanos-usuarios. Más concretamente, definir ese ámbito para evaluar si la gestión de la atención primaria de salud (a nivel federal, estatal y municipal) ofrece calidad en la prestación de los servicios. Por lo tanto, se consideró que la calidad deriva -entre otras variables- de las acciones gerenciales (procesos de gestión) implementadas para la atención primaria de salud.

Dicha auditoría abarcó un trabajo de campo -de manera espontánea- en 23 estados y 317 ciudades, cuyos resultados se sumaron con una encuesta electrónica respondida por 14 Direcciones Estatales de Salud, 2.577 Direcciones Municipales de Salud y 175 Gerencias Regionales de Salud. Las preguntas de la auditoría se desarrollaron en torno a tres grandes temas: planificación, gestión de personas y seguimiento y evaluación.

El Resumen Ejecutivo presenta los principales resultados de la auditoría realizada; y constituye una herramienta estratégica para mejorar la gestión de dichos servicios, ya que ofrece un excelente diagnóstico de la infraestructura, el acceso, la prestación de servicios y la capacidad de resolución de problemas de la atención primaria de salud. El informe contiene referencias a las buenas prácticas.

Fuente: https://portal.tcu.gov.br/biblioteca-digital/auditoria-coordenada-na-atencao-basica-a-saude.htm

GESTÃO DA SAÚDE NO BRASIL - Auditoria Coordenada (Resumo Executivo)

Report ID: 365

Com uma grande população, o Brasil tem como uma de suas missões mais difíceis e complexas assegurar o acesso universal, igual e gratuito aos serviços de saúde, direito consagrado na própria Constituição Federal. Neste sentido, a implementação de tais políticas públicas enfrenta muitos desafios, como no caso da descentralização das ações, das fontes de financiamento, dos recursos humanos necessários e da gestão dos recursos financeiros disponíveis.

A atenção primária à saúde é o principal ponto de entrada e o eixo de comunicação de toda a rede de saúde; e deve ser o contato preferencial dos usuários do Sistema Único de Saúde (SUS). Neste nível de atendimento, são identificadas as principais necessidades da população, e isso tem influência no planejamento e gestão das outras camadas.

A atenção primária à saúde foi objeto desta auditoria de desempenho coordenada conduzida pelo Tribunal Federal de Contas (TCU) e por 29 Tribunais de Contas (TC), signatários do Acordo de Cooperação Técnica celebrado em 25 de março de 2014. O objetivo desta auditoria foi avaliar, através de uma auditoria coordenada, aspectos relacionados à prestação de serviços, acesso, infra-estrutura e capacidade de solução de problemas da atenção primária à saúde dos cidadãos-usuários. Mais especificamente, definir esse escopo para avaliar se a gestão da atenção primária à saúde (nos níveis federal, estadual e municipal) proporciona qualidade na prestação de serviços. Portanto, foi considerado que a qualidade deriva - entre outras variáveis - de ações gerenciais (processos de gestão) implementadas para a atenção primária à saúde.

Tal auditoria envolveu trabalho de campo - de forma espontânea - em 23 estados e 317 cidades, cujos resultados foram adicionados com uma pesquisa eletrônica respondida por 14 Departamentos Estaduais de Saúde, 2.577 Departamentos Municipais de Saúde e 175 Delegacias Regionais de Gestão de Saúde. As questões de auditoria foram desenvolvidas em torno de três grandes temas: planejamento, gestão de pessoas, e monitoramento e avaliação.

O Resumo Executivo apresenta os principais resultados da auditoria que foi realizada; e constitui uma ferramenta estratégica para melhorar a gestão desses serviços, pois oferece um excelente diagnóstico da infra-estrutura, acesso, prestação de serviços e a capacidade de resolução de problemas da atenção primária de saúde. O relatório contém referências a boas práticas.

Fonte: https://portal.tcu.gov.br/biblioteca-digital/auditoria-coordenada-na-atencao-basica-a-saude.htm

Joint Report on the Results of the International Audit on Waste Management and Utilization

Report ID: 366

The International Coordinated Audit on Waste Management and Utilization was conducted in the framework of the EUROSAI Working Group on the Audit of Funds Allocated to Disasters and Catastrophes. The purposes of the national audits – were to assess the state and efficiency of the waste management system in the countries participants of the audit.

The Supreme Audit Institutions (SAIs) of Moldova, Serbia and Ukraine participated in the audit. The SAI of Ukraine was the audit coordinator, The aim of national audits was to assess the state and effectiveness of the waste management system in countries of SAIs– participants of the international audit. The scope of the audit comprised from 2015-2018.

The results of the national audits conducted in the field of household, industrial and other hazardous waste, which can pose a serious threat to human health and the environment, as well as lead to environmental and man-made disasters, showed: for those countries, whose SAIs participated in the audit, common inconsistencies/gaps and problems within existing waste management systems

The results of the cooperative audit indicate the need to strengthen the governments’ efforts to move from the existing linear economy to a circular economy based on the maximum processing of waste generated in the territories of countries as well as the creation of an integrated waste management system in accordance with the EU “waste management hierarchy” in order to reduce the negative impact on the environment, public health and prevent the occurrence of environmental and man-made disasters.

Fuente:  EUROSAI Database of Audits -  https://www.eurosai.org/en/databases/audits/Joint-Report-on-the-Results-of-the-International-Audit-on-Waste-Management-and-Utilization/

Coordinated Audit on upper secondary education in Brazil

Report ID: 367

In 2013, the Federal Court of Accounts (TCU) and other 28 Brazilian courts of accounts conducted a coordinated audit to identify problems affecting the quality and coverage of upper secondary education in Brazil and to evaluate the government actions aimed at removing or lessening their causes. For this purpose they signed a Technical Cooperation Agreement on 21/03/2013.

The audit was carried out by over 90 auditors throughout the 2013 financial year. They visited about 580 schools across Brazil. The audit was aimed to identify the main problems affecting the quality and Introduction coverage of secondary education in Brazil, as well as to assess government actions that seek to eliminate or mitigate their causes.

The scope of the audit was guided by five thematic axes: management; infrastructure; teachers; financing and coverage, the first two being part of the common core of issues that were evaluated by all the participating Audit Courts. The audit focused on regular high school education, not being analyzed the Youth and Adult Education (EJA) and the Adult Education (EJA) and professional education were not analyzed.

Upper secondary education, aimed at young people aged 15 to 17, was chosen because it is the phase in lower education faced with great challenges regarding the improvement of education outcomes and of educational indicators. States are mandated to place a higher priority on upper secondary education delivery. The public state education networks comprise about 85% of the total enrollments of this schooling phase.

Source: https://portal.tcu.gov.br/biblioteca-digital/auditoria-coordenada-no-ensino-medio.htm

Executive Summary Renewable Sources – Coordinated Audit

Report ID: 369

The Latin American and Caribbean Organization of Supreme Audit Institutions (OLACEFS), through the Public Works Audit Working Group (GTOP), chose the topic of renewable energies in the electricity sector to carry out a coordinated audit. Due to the importance of the expansion of renewable energy for mitigating the effects of climate change, this audit had the technical support through the Deutsche Gesellschaft für Internationale Zusammenarbeit GmbH (GIZ), within the scope of the project Strengthening External Control in the Environmental Area.

The Supreme Audit Institutions of Brazil (Coordinator), Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Paraguay and Venezuela participated in the joint work. This made it possible to promote an exchange of information on the energy policies adopted in each country and a subsequent consolidation of the results of the audit, with the aim of contributing to the improvement of strategies aimed at expanding clean sources in the electricity matrix.

The purpose of the audit was to evaluate the public policies for the inclusion of renewable sources in the electricity generation mix of the participating countries, including the international commitments assumed, as well as related governmental guidelines, especially identifying good practices and opportunities for improvement in these policies, so as to contribute to the achievement of the commitments assumed through the Sustainable Development Goals (SDG) and the Paris Agreement.

The specific objectives addressed by the coordinated audit were:

1) To identify the current situation of the electricity matrix in each of the OLACEFS participating member countries;

2) To evaluate whether there are public policies in place to achieve national and/or international commitments for the expansion of renewable energies in the electricity sector, especially for the achievement of the Sustainable Development Goals and the Paris Agreement;

3) Analyze investments in infrastructure for the generation of sustainable electrical energy (water, wind, solar, biomass, tidal, etc.) and possible existing barriers to the insertion/expansion of this infrastructure, especially in relation to aspects related to operational challenges, regulatory issues, subsidy and promotion policies, energy security, energy prices, tariff modulation, among others. The report contains good practices.

* The executive summary is available in Portuguese and Spanish on this catalogue.

Source: https://portal.tcu.gov.br/data/files/FE/42/A0/E2/A500371055EB6E27E18818A8/Energias_renovaveis_ingles.pdf